Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF QUINIDINE

Facility

$67.00

Service Code	CPT 80194 90
Hospital Charge Code	900910456
Hospital Revenue Code	301
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$50.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$40.20
Rate for Payer: Aetna of CA Government/Medicare	$40.20
Rate for Payer: Cash Price	$30.15
Rate for Payer: Health Smart Auto/Commercial	$40.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$40.20
Rate for Payer: LLUH Dept of Risk Management WC	$36.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$50.25

HC LAB REF QUINIDINE

Facility

$67.00

Service Code	CPT 80194
Hospital Charge Code	900910456
Hospital Revenue Code	301
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$53.60
Rate for Payer: Cash Price	$30.15
Rate for Payer: Cigna of CA HMO/PPO	$53.60
Rate for Payer: Health Smart Auto/Commercial	$40.20
Rate for Payer: LLUH Dept of Risk Management WC	$36.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$50.25

HC LAB REF QUINIDINE

Facility

$67.00

Service Code	CPT 80194 90
Hospital Charge Code	900910456
Hospital Revenue Code	301
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$53.60
Rate for Payer: Cash Price	$30.15
Rate for Payer: Cigna of CA HMO/PPO	$53.60
Rate for Payer: Health Smart Auto/Commercial	$40.20
Rate for Payer: LLUH Dept of Risk Management WC	$36.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$50.25

HC LAB REF RAJI CELL

Facility

$168.00

Service Code	CPT 86332
Hospital Charge Code	900911007
Hospital Revenue Code	302
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$134.40
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cigna of CA HMO/PPO	$134.40
Rate for Payer: Health Smart Auto/Commercial	$100.80
Rate for Payer: LLUH Dept of Risk Management WC	$92.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$126.00

HC LAB REF RAJI CELL

Facility

$168.00

Service Code	CPT 86332 90
Hospital Charge Code	900911007
Hospital Revenue Code	302
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$134.40
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cigna of CA HMO/PPO	$134.40
Rate for Payer: Health Smart Auto/Commercial	$100.80
Rate for Payer: LLUH Dept of Risk Management WC	$92.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$126.00

HC LAB REF RAJI CELL

Facility

$168.00

Service Code	CPT 86332 90
Hospital Charge Code	900911007
Hospital Revenue Code	302
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$100.80
Rate for Payer: Aetna of CA Government/Medicare	$100.80
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Smart Auto/Commercial	$100.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$100.80
Rate for Payer: LLUH Dept of Risk Management WC	$92.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$126.00

HC LAB REF RAJI CELL

Facility

$168.00

Service Code	CPT 86332
Hospital Charge Code	900911007
Hospital Revenue Code	302
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$100.80
Rate for Payer: Aetna of CA Government/Medicare	$100.80
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Smart Auto/Commercial	$100.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$100.80
Rate for Payer: LLUH Dept of Risk Management WC	$92.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$126.00

HC LAB REF RENIN ACT PLASMA

Facility

$15.00

Service Code	CPT 84244 90
Hospital Charge Code	900910955
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC LAB REF RENIN ACT PLASMA

Facility

$15.00

Service Code	CPT 84244
Hospital Charge Code	900910955
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC LAB REF RENIN ACT PLASMA

Facility

$15.00

Service Code	CPT 84244
Hospital Charge Code	900910955
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$12.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Cigna of CA HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC LAB REF RENIN ACT PLASMA

Facility

$15.00

Service Code	CPT 84244 90
Hospital Charge Code	900910955
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$12.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Cigna of CA HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC LAB REF REPTILASE TIME

Facility

$16.00

Service Code	CPT 85635 90
Hospital Charge Code	900910114
Hospital Revenue Code	305
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC LAB REF REPTILASE TIME

Facility

$16.00

Service Code	CPT 85635 90
Hospital Charge Code	900910114
Hospital Revenue Code	305
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.80
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of CA HMO/PPO	$12.80
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC LAB REF REPTILASE TIME

Facility

$16.00

Service Code	CPT 85635
Hospital Charge Code	900910114
Hospital Revenue Code	305
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC LAB REF REPTILASE TIME

Facility

$16.00

Service Code	CPT 85635
Hospital Charge Code	900910114
Hospital Revenue Code	305
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.80
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna of CA HMO/PPO	$12.80
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC LAB REF RETICULIN AB

Facility

$14.00

Service Code	CPT 86255
Hospital Charge Code	900910788
Hospital Revenue Code	302
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.40
Rate for Payer: Aetna of CA Government/Medicare	$8.40
Rate for Payer: Cash Price	$6.30
Rate for Payer: Health Smart Auto/Commercial	$8.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.40
Rate for Payer: LLUH Dept of Risk Management WC	$7.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.50

HC LAB REF RETICULIN AB

Facility

$14.00

Service Code	CPT 86255 90
Hospital Charge Code	900910788
Hospital Revenue Code	302
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.40
Rate for Payer: Aetna of CA Government/Medicare	$8.40
Rate for Payer: Cash Price	$6.30
Rate for Payer: Health Smart Auto/Commercial	$8.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.40
Rate for Payer: LLUH Dept of Risk Management WC	$7.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.50

HC LAB REF RETICULIN AB

Facility

$14.00

Service Code	CPT 86255 90
Hospital Charge Code	900910788
Hospital Revenue Code	302
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$11.20
Rate for Payer: Health Smart Auto/Commercial	$8.40
Rate for Payer: Cash Price	$6.30
Rate for Payer: Cigna of CA HMO/PPO	$11.20
Rate for Payer: LLUH Dept of Risk Management WC	$7.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.50

HC LAB REF RETICULIN AB

Facility

$14.00

Service Code	CPT 86255
Hospital Charge Code	900910788
Hospital Revenue Code	302
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$11.20
Rate for Payer: Cash Price	$6.30
Rate for Payer: Cigna of CA HMO/PPO	$11.20
Rate for Payer: Health Smart Auto/Commercial	$8.40
Rate for Payer: LLUH Dept of Risk Management WC	$7.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.50

HC LAB REF RIFAMPIN

Facility

$137.00

Service Code	CPT 80299 90
Hospital Charge Code	900911389
Hospital Revenue Code	301
Min. Negotiated Rate	$75.35
Max. Negotiated Rate	$102.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$82.20
Rate for Payer: Aetna of CA Government/Medicare	$82.20
Rate for Payer: Cash Price	$61.65
Rate for Payer: Health Smart Auto/Commercial	$82.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$82.20
Rate for Payer: LLUH Dept of Risk Management WC	$75.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$102.75

HC LAB REF RIFAMPIN

Facility

$137.00

Service Code	CPT 80299
Hospital Charge Code	900911389
Hospital Revenue Code	301
Min. Negotiated Rate	$75.35
Max. Negotiated Rate	$109.60
Rate for Payer: Cash Price	$61.65
Rate for Payer: Cigna of CA HMO/PPO	$109.60
Rate for Payer: Health Smart Auto/Commercial	$82.20
Rate for Payer: LLUH Dept of Risk Management WC	$75.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$102.75

HC LAB REF RIFAMPIN

Facility

$137.00

Service Code	CPT 80299 90
Hospital Charge Code	900911389
Hospital Revenue Code	301
Min. Negotiated Rate	$75.35
Max. Negotiated Rate	$109.60
Rate for Payer: Cash Price	$61.65
Rate for Payer: Cigna of CA HMO/PPO	$109.60
Rate for Payer: Health Smart Auto/Commercial	$82.20
Rate for Payer: LLUH Dept of Risk Management WC	$75.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$102.75

HC LAB REF RIFAMPIN

Facility

$137.00

Service Code	CPT 80299
Hospital Charge Code	900911389
Hospital Revenue Code	301
Min. Negotiated Rate	$75.35
Max. Negotiated Rate	$102.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$82.20
Rate for Payer: Aetna of CA Government/Medicare	$82.20
Rate for Payer: Cash Price	$61.65
Rate for Payer: Health Smart Auto/Commercial	$82.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$82.20
Rate for Payer: LLUH Dept of Risk Management WC	$75.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$102.75

HC LAB REF RISPERIDONE

Facility

$96.00

Service Code	CPT 80342
Hospital Charge Code	900910787
Hospital Revenue Code	301
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$76.80
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cigna of CA HMO/PPO	$76.80
Rate for Payer: Health Smart Auto/Commercial	$57.60
Rate for Payer: LLUH Dept of Risk Management WC	$52.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$72.00

HC LAB REF RISPERIDONE

Facility

$96.00

Service Code	CPT 80342 90
Hospital Charge Code	900910787
Hospital Revenue Code	301
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.60
Rate for Payer: Aetna of CA Government/Medicare	$57.60
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Smart Auto/Commercial	$57.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.60
Rate for Payer: LLUH Dept of Risk Management WC	$52.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$72.00

Know your out-of-pocket cost for care.

All Charges